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«LIKES - Research Reports on Sport and Health 305 THE MINDFULNESS, ACCEPTANCE AND COMMITMENT APPROACH TO ENCOURAGING A PHYSICALLY MORE ACTIVE ...»

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LIKES - Research Reports on Sport and Health 305

THE MINDFULNESS, ACCEPTANCE AND

COMMITMENT APPROACH TO ENCOURAGING

A PHYSICALLY MORE ACTIVE LIFESTYLE

ANU KANGASNIEMI

Esitetään Jyväskylän yliopiston yhteiskuntatieteellisen tiedekunnan

suostumuksella julkisesti tarkastettavaksi Agora Centerin Lea Pulkkisen salissa lokakuun 9. päivänä 2015 klo 12.

Academic dissertation to be publicly discussed, by permission of the Faculty of Social Sciences of the University of Jyväskylä, in the Lea Pulkkinen auditorium, on 9 October, 2015, at 12 o’clock.

LIKES – Research Center for Sport and Health Sciences Jyväskylä 2015 University of Jyväskylä Faculty of Social Sciences Department of Psychology Author’s address Anu Kangasniemi LIKES – Research Center for Sport and Health Sciences Viitaniementie 15a, 40720 Jyväskylä, Finland anu.kangasniemi@likes.fi Supervisors Raimo Lappalainen Department of Psychology University of Jyväskylä Tuija Tammelin LIKES – Research Center for Sport and Health Sciences Reviewers Stuart Biddle Victoria University, Australia Joseph Ciarrochi Australian Catholic University, Australia Opponent Stuart Biddle Victoria University, Australia LIKES – Research Reports on Sport and Health 305 ISBN (nid.) 978-951-790-390-5 ISBN (pdf) 987-951-790-391-2 ISSN 0357-2498 | 2342-4788 Editor Tuija Tammelin Distribution LIKES – Research Center for Sport and Health Sciences Viitaniementie 15a, FI-40720 Jyväskylä, Finland Printing Digipaino Kirjaksi.Net Copyright© 2015, Anu Kangasniemi & LIKES – Research Center for Sport and Health Sciences ABSTRACT Kangasniemi, Anu The mindfulness, acceptance and commitment approach to encouraging a physically more active lifestyle LIKES – Research Reports on Sport and Health 305 Jyväskylä: LIKES – Research Center fort Sport and Health Sciences, 2015.

The aims of this research were to examine the differences in psychological well-being between physically less active and active adults and to explore the effectiveness of an acceptance- and commitment-based behavioural intervention in encouraging a physically more active lifestyle among physically inactive adults.

The dissertation included a randomised controlled trial (RCT) among physically inactive adults aged 30 to 50 years (N=138) and a cross-sectional study on physically active (N=50) and less active adults (N=58). In the cross-sectional study, the participants completed a questionnaire reporting their mindfulness skills, psychological flexibility, and psychological and depressive symptoms. In both studies, physical activity was self-reported and measured using accelerometers. In the RCT, physically inactive participants were randomly allocated to a feedback-only group (FB, N=69) or to an acceptance- and commitmentbased behavioral intervention group (ACT+FB, N=69). Both groups received written feedback concerning their physical activity and were offered a body composition analysis. In addition, the ACT+FB group attended six 1.5- hour group sessions and were given a pedometer during the nine-week intervention. All participants’ self-efficacy, planning and acceptance of psychological and physical discomfort related to physical activity were evaluated at baseline and at three- and six-month follow-ups.

Physically active individuals had better mindfulness skills and less psychological and depressive symptoms compared to physically less active adults. No difference was observed in the change of physical activity between the FB and ACT+FB groups over time. Participants in both groups increased their physical activity with high individual differences. Self-efficacy, planning, and the acceptance of psychological and physical discomfort related to physical activity improved more in the ACT+FB group than in the FB group. In addition, after reanalysing the data among non-depressive adults, a higher stability was observed regarding objectively measured physical activity at the individual level between the three- and sixmonth follow-ups in the ACT+FB group as compared to the FB group. Furthermore, the change in acceptance of discomfort related to physical activity was associated with positive change in self-reported physical activity, but not with accelerometer-based physical activity and also mediated the association between change in barriers self-efficacy and change in self-reported physical activity in the ACT+FB group.

The results indicate that having a physically active lifestyle is related to better psychological well-being and mindfulness skills. Moreover, the results suggest that the ACT+FB intervention was beneficial in supporting the physically inactive adults´ cognitive change related to physical activity and brought about a more stable improvement in physical activity behaviour at the individual level, especially among the non-depressive participants. The novel findings also suggest that the acceptance of discomfort related to physical activity may play an important, beneficial role when trying to change to a physically more active lifestyle.

Keywords: acceptance, physically inactive adults, behaviour change, commitment, mindfulness, physical activity, psychological flexibility.

TIIVISTELMÄ Kangasniemi, Anu Fyysisesti aktiivisempi elämäntapa arvo- ja hyväksyntäpohjaisen lähestymistavan avulla Liikunnan ja kansanterveyden julkaisuja 305 Jyväskylä: LIKES-tutkimuskeskus, 2015.





Tutkimuksen tavoitteena oli selvittää tietoisuustaitojen, psykologisen joustavuuden ja psykologisten oireiden eroja vähän liikkuvilla ja aktiivisesti liikkuvilla aikuisilla sekä tutkia hyväksyntä- ja arvopohjaisen hyvinvointiohjelman vaikuttavuutta fyysisesti aktiivisempaan elämäntapamuutokseen vähän liikkuvilla aikuisilla.

Tutkimus koostui satunnaistetusta ja kontrolloidusta koeasetelmasta, jonka kohderyhmänä olivat vähän liikkuvat aikuiset (N=138). Lisäksi tutkimukseen kuului poikkileikkausasetelma, jossa verrattiin aktiivisten liikkujien (N=50) ja vähän liikkuvien aikuisten (N=58) tietoisuustaitoja, psykologista joustavuutta ja psykologisia oireita kyselylomakkeilla. Vähän liikkuvat aikuiset satunnaistettiin kahteen eri ryhmään. Palauteryhmä sai palautetta fyysisestä aktiivisuudestaan tutkimuksen alussa sekä 3 ja 6 kuukauden seurannassa. Arvopohjainen ryhmä sai saman palautteen kuin edellä ja osallistui hyvinvointiohjelmaan, johon kuului askelmittareiden käyttäminen 9 viikon aikana sekä pienryhmätapaamiset. Pienryhmätapaamisia oli yhteensä 6 x 1,5 tuntia. Niiden sisältö pohjautui hyväksymisja omistautumisterapian periaatteisiin, joiden tavoitteena on psykologisen joustavuuden kehittäminen arvoja, hyväksyntää ja tietoisuustaitoja hyödyntäen. Kummassakin osatutkimuksessa fyysistä aktiivisuutta mitattiin kiihtyvyysmittareilla ja itseraportoidusti. Tutkittavien minäpystyvyyden tunnetta, suunnittelun taitoja sekä liikuntaan liittyvien epämiellyttävien psykologisten ja fyysisten tuntemusten hyväksyntää tutkittiin tutkimuksen alussa sekä 3 ja 6 kuukauden seurannassa.

Tutkimustulosten mukaan fyysisesti aktiivisemmilla liikkujilla oli paremmat tietoisuustaidot ja vähemmän psykologisia oireita verrattuna vähän liikkuviin aikuisiin. Sekä arvopohjaisessa että palauteryhmässä fyysinen aktiivisuus lisääntyi 3 ja 6 kuukauden seurannassa, eikä fyysisen aktiivisuuden muutoksissa ollut eroa ryhmien välillä. Yksilölliset vaihtelut muutoksessa olivat kuitenkin suuria. Arvopohjaisessa ryhmässä minäpystyvyyden tunne, liikuntaan liittyvä suunnittelu sekä liikkumiseen liittyvien epämiellyttävien ajatusten, tunteiden ja fyysisten tuntemusten hyväksyntä parantui enemmän verrattuna palauteryhmään. Edelleen havaittiin, että kiihtyvyysmittarilla mitatun fyysisen aktiivisuuden muutokset olivat yksilöllisesti tarkasteltuna pysyvämpiä arvopohjaisessa ryhmässä verrattuna palauteryhmään niiden osallistujien joukossa, jotka eivät olleet masentuneita. Arvopohjaisessa ryhmässä muutos liikuntaan liittyvien epämiellyttävien tuntemusten hyväksynnässä oli yhteydessä itseraportoituun liikunta-aktiivisuuden muutokseen. Muutos hyväksynnässä välitti myös esteisiin liittyvän minäpystyvyyden muutoksen ja itseraportoidun liikuntamuutoksen välistä yhteyttä.

Tutkimustulokset antavat viitteitä siitä, että psyykkinen hyvinvointi ja tietoisuustaidot liittyvät fyysisesti aktiivisempaan elämäntapaan. Arvoja, hyväksyntää ja tietoisuustaitoja painottavan lähestymistavan avulla saattaisi olla mahdollista tukea muutokseen liittyvää ajattelutapaa sekä edistää fyysisen aktiivisuuden muutosten pysyvyyttä.

Avainsanat: vähän liikkuvat aikuiset, arvot, fyysinen aktiivisuus, elämäntapamuutos, hyväksyntä, liikunta, psykologinen joustavuus, tietoisuustaidot.

ACKNOWLEDGEMENTS

With a sense of joy, excitement and relief I write these last sentences of my PhD dissertation. Writing this study has been truly a great adventure, giving me new experiences and challenges. I feel that I have learnt a lot, both personally and professionally.

There are many people to whom I want to express my deepest gratitude. First and foremost I want to thank my supervisors, Professor Raimo Lappalainen and our research director of LIKES Dr. Tuija Tammelin. Thank you Raimo for sharing your knowledge and wisdom, and guiding me through the world of ACT. You have an amazing ability to encourage and guide people around you, always with a warm sense of joy. I also want to thank you, Tuija, for your careful comments, guidance and encouragement along the way. You had a great role in enabling this study from research plan into practise.

This study included many phases – from collecting the data to statistical analysis and writing. I am grateful to Anna Kankaanpää for analysing the data, being patient and enterprising all the way. It was not easy, that first time, making sense of the RCT data, and your statistical skills were essential. Thank you, Professor Asko Tolvanen for your valuable advice with the statistical analysis and the enjoyable meetings, even if we always had difficult questions for you. Warmest thanks to Janne Kulmala, Kirsti Siekkinen, Harto Hakonen and Virpi Inkinen who contributed to collecting the data. I also thank Essi Sairanen, Henna-Riikka Hoffren and Tanja Onatsu for your help in running the intervention groups, and Annaleena Aira for communicating the results to the outside world.

I also want to express my gratitude to my late colleague, Dr. Esa Rovio, who had a very special role at the beginning of my study. He encouraged me to write my research plan as a part of his bigger research plan, and I am very thankful for his pioneering work in this field. I still admire his courage, strength, belief and acceptance in the face of his serious illness. I also thank my great teacher in the past, Professor Taru Lintunen, whose inspiration and knowledge had been significant during my years as a young student. The impact of her teaching had long-lasting effects and after many years I still find the psychology of physical activity a fascinating field, and well worth committing my time to.

My sincere thanks go to Professor Stuart Biddle and Professor Joseph Ciarrochi for reviewing and giving valuable comments during the last phase of this dissertation. I admire your work and it was a great honour to have you both as my reviewers.

I have been fortunate in having the great support of my lovely colleagues. After four years I feel that we have become good friends. Thank you Kati K, Jaana, Maarit, Kirsti, Nina, Virpi, Katariina and many others for sharing this journey with me. You have given me so much joy and faith when it was sorely needed. I have enjoyed your company and our discussions, not only related to work, but also many other important issues related to everyday living.

My sincere thanks go to our director Eino Havas. You believed in my ideas, even though the combination of therapy and physical activity might have sounded a bit strange in 2009 when I was first writing the research plan. You are a very special person who has the ability to look to the future and the flexibility to go on.

I also want to thank my two brothers and my parents Lea and Antero. You have given me a strong foundation on which to build my life. Your love, warm support and help, together with my parents-in-law Marjatta and Erkki, have been more than important.

I am also grateful to have very good friends, some of whom I have been lucky to know for over 30 years. Thank you ‘girls’ for your friendship and being in my life.

You are very important for me.

And last, but not least I feel a bit a sense of pride and unconditional love when I think of my own family: Miska and my wonderful kids, Emil, Ada and Aino. Thank you Miska for your endless support and love. You are a great husband and father.

Emil, Ada and Aino – there’s nothing that compares to you and not enough words to express my feelings. I hope that your hearts will always know how much I love and care for you.

Jyväskylä 17.08. 2015 This study was funded by the Finnish Ministry of Education and Culture and Juho Vainio säätiö.

LIST OF ORIGINAL PUBLICATIONS

The thesis is based on the following original publications, which are referred to in the text by their Roman numerals.

I Kangasniemi, A., Lappalainen, R., Kankaanpää A. & Tammelin, T. 2014.

Mindfulness skills, psychological flexibility, and psychological symptoms among physically less active and active adults. Mental Health and Physical Activity 7 (3), 121–127.

II Kangasniemi, A.M., Lappalainen, R., Kankaanpää, A., Kulmala, J., Hakonen, H. & Tammelin, T. 2013. Towards a physically more active lifestyle based on one´s own values: study design of a randomized controlled trial for physically inactive adults. BMC Public Health 13: 671.

III Kangasniemi, A.M., Lappalainen, R., Kankaanpää, A., Tolvanen A. & Tammelin, T. 2015. Towards a physically more active lifestyle based on one´s own values: the results of a randomized controlled trial among physically inactive adults. BMC Public Health 15:260.

IV Kangasniemi, A.M., Lappalainen, R., Kankaanpää, A. Tolvanen A. & Tammelin, T. The role of acceptance of discomfort related to physical activity for change in physical activity behaviour among physically inactive adults. Submitted.



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